A primer on health facilities management

Finding excellent mentors can be a key ingredient to a young health facilities manager's success in the field.

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Health care facilities managers (HFMs) are perhaps most visible in a facility when running down the hall to address an emergency. An outside observer might see this and think that an HFM’s only role is to fix things when they break. In actuality, HFMs perform many highly complex jobs critical to the health care facility’s function — and most HFMs will also roll up their sleeves to solve an immediate problem.

As a result of their direct effect on patient welfare, the planning, design, and construction (PDC); maintenance; and daily operations of health care facilities are heavily regulated by numerous, wide-ranging authorities and must respond to high-impact needs that are constantly and rapidly evolving. Most importantly, a health care facility must provide continuous patient care; if it fails even briefly, the results can be disastrous.

A successful HFM wears many hats: decoder, chronicler, planner, monitor, negotiator, leader, teammate and saver-of-the-day, just to name a few. A new American Society for Health Care Engineering (ASHE) handbook, Introduction to Health Care Facilities Management, discusses the primary skills and concepts an HFM should use and understand, and it offers a detailed look at various types of health care facilities, a typical hospital’s structure and the business of health care.

The following article was excerpted and edited from this in-depth ASHE reference.

Broad skills

Effective HFMs do not need to have every code and concept diligently memorized; although, over time, many outwardly complicated aspects of the job and how they apply to a particular facility will become second nature. There are a few broad skills, however, that are important to cultivate from the get-go: communicating, problem solving, and planning and prioritizing. The more HFMs master and incorporate these skills into their work, the fewer unnecessary barriers will crop up. They include:

Communicating. Communication skills not only will allow HFMs to satisfactorily express what is and is not possible in the facility but also will create space for others to provide the information needed to run the facility optimally. HFMs need to understand how to communicate with everyone, including their team members, the C-suite, the nursing staff and beyond. 

When a problem arises, HFMs need to consider who to consult and who to inform. They must keep people in the facility apprised of any problems and the measures that are being taken to resolve them. More routinely, HFMs must round, or tour, a significant part of their building routinely (e.g., daily or weekly) and make the rounds of more distant facilities on a frequent and regular basis.

Problem solving. Problem solving is a major component across most of an HFM’s responsibilities. And often, HFMs need to solve those problems with the materials on hand in whatever all-too-brief time is available. Problem solving should involve looking for and remediating the possible effects of the original problem, investigating to learn the source or cause of the problem, determining the magnitude of the problem, creating a plan to prevent this sort of problem from arising again, and communicating to all stakeholders and regulators what has been done as well as the plan for preventing the problem from recurring.

Planning and prioritizing. HFMs typically need to problem solve after a problem occurs, but an effective HFM will anticipate problems and prevent them from arising in the first place. With the number of responsibilities on an HFM’s plate, another important skill is assessing risk and prioritizing ­— simply put, planning.

One way to tackle this is to put the HFM’s responsibilities into three categories: 1) urgent and important; 2) just important; and 3) neither urgent nor important. Then, they can be addressed in that order. 

Even though the items in the third category fall at the end of the list, HFMs may want to make a point of fitting one of these into each week so that they eventually attend to them. Otherwise, the items might wind up being transferred from list to list. If HFMs have a lot of items in the first category, they should go through those and rank them in order of the seriousness of their consequences. 

In addition to supporting the HFM’s day-to-day responsibilities, assessing risk and prioritization is critical when managing specific projects. There are a great number of existing tools and processes out there to assist HFMs with planning and mitigating risk, such as infection control risk assessments, preconstruction risk assessments and hazard vulnerability analyses, as well as guides from the International Organization for Standardization, the National Fire Protection Association, ASHE and others.

The broad skills discussed in this section will be essential to the HFM’s engagement and understanding of their facility, which will fuel their ability to eradicate obstacles as they arise. As an HFM reads on, they should try to identify areas where these broad skills may come in handy.

Specific responsibilities

An HFM equipped with the requisite communication, problem-solving and prioritization skills will need to apply them to a wide range of responsibilities. Before diving into these, it’s important to remember that no two health care facilities are alike. Of course, this is true among different types of health care facilities, but even facilities offering identical services will be unique in their location, culture, operation, organization and staff. It will be just as important for an HFM to learn the breadth of their responsibilities as it is to learn how they are tailored to a specific facility.

The health care facilities management department is an HFM’s home base in a hospital, but the role will usually have them traveling throughout the facility. Typically housed under a health care organization’s support services, facilities management involves operations and maintenance, including meeting the needs of each department; staying compliant with codes, standards and regulations (many of which pertain to fire and life safety); participating in the PDC process; and understanding the environment’s effect on patient satisfaction.

In addition to HFMs, professionals who work in this area can include carpenters; electricians; engineers; heating, ventilation, air conditioning and refrigeration specialists; water system specialists; sewage system specialists; plumbers; construction workers; technicians; and others. The department typically has contracts with service professionals to maintain elevators and pneumatic tubes and works with infection prevention to check air quality (as opposed to airflow, pressure and frequency of air exchanges, which are the HFM’s jurisdiction).

General areas and systems that health care facilities management typically oversee include fire drills; fire preparedness; inspection, testing and maintenance of fire alarm systems, fire protection and suppression systems, medical gas and vacuum systems, medical equipment and medical equipment risks, utility systems and utility system risks, and essential electrical systems; steam and hot water; water and sewage systems; heating, ventilation, air conditioning and refrigeration; electrical distribution systems; grounds; Life Safety Code^® compliance; life safety during construction; and preparation for surveys. 

There is a wide variety of entities and departments within a hospital with specific and occasionally competing needs and priorities. It is the HFM’s responsibility to apply these duties throughout these departments (e.g., provide medical gases, manage positive/negative pressure where appropriate), as well as address their requests and concerns. 

In addition, HFMs will need to maintain high levels of communication with department leadership and staff to ensure that any work they are doing in the facility does not interrupt their operations, as well as to ensure that changes they have planned independently will not cause safety or compliance issues. 

Ensuring compliance. A crucial part of the HFM’s job is ensuring that the facility complies with all applicable codes, standards and regulations, which includes being aware of the facilities’ occupancy types and provider types, as well as additional requirements or contractual obligations that the organization is under (e.g., with insurance providers or physician groups). Compliance can affect everything from the facility’s funding, such as Centers for Medicare & Medicaid Services (CMS) reimbursements, to whether the facility is allowed to continue serving patients.

Understanding compliance feels overwhelming, and not without reason. HFMs will need to comply with a variety of codes, many of which provide the same or similar requirements for a facility. When this is the case, it is usually a good rule of thumb to follow the code or standard that is most strict, as that implementation will likely also meet the requirements of the less stringent code. However, different authorities, codes and standards can also bring in competing or contradicting requirements, which can make the HFM’s job very interesting indeed.

Engaging in the PDC process. HFMs should think of the physical environment as another team member — a presence that supports their work and the work of their health care colleagues. Effective health care PDC aims to provide environments conducive to the tasks being done there and can help improve the care delivered within its spaces. By the same token, when not planned well, the design can degrade the health care experience or impede its delivery.

For this reason, architects, designers, engineers and (ideally but atypically) HFMs, infection preventionists and environmental services staff work together on PDC. Their collaboration ensures that the best designs for everyone are achieved. Strong PDC involves proactively asking questions about why something is being done, what the desired outcome is and what is likely to happen as a consequence of implementing each potential element.

Administrative, managerial and financial responsibilities. HFMs have to figure how many people they need to staff a facility during its hours of operation. That involves taking into consideration any requirements for staffing imposed by CMS or other regulating agencies’ rules; weekend coverage; staff sick days, personal days and holidays; and the skills, training and other qualifications each member of the staff possesses to make appropriate work assignments for them.

Keeping documentation up to date and in order is also up to HFMs, and they don’t want to put off this task because the documenting can quickly mount up and become disorganized. When a survey occurs, there is a documentation review step during which HFMs must be able to present documentation to support the initiatives they accomplished and the strategies employed to complete them.

HFMs need to train their staff on how to do specific jobs and work in particular areas. They also have to train vendors who may be unfamiliar with the stringent codes to which they must adhere when working within a health care facility, and HFMs don’t want their work to result in the facility becoming out of compliance or threatening the safety of colleagues and patients.

As a leader, the HFM will also be responsible for hiring and mentoring each person, as well as ensuring that everyone collaborates well with everyone else (including people outside of the department) speaks and acts in a professional manner, and is adhering to rules and fulfilling their responsibilities well and efficiently. To that end, HFMs will be in charge of doing performance reviews at least once a year and, if needed, performance plans. HFMs may need to form a panel of folks to help them assess prospective employees, vendors or service contractors.

An HFM’s financial responsibilities include staying within or under budget. They also include understanding leases and business agreements, finding cost savings and being able to explain the financial implications of their department to various leaders in their organization (including the cost of incompliance). 

To prepare for lease expirations, HFMs should stay apprised of the cost of properties their organization leases to or from others and how their cost compares with market values. The HFM’s duties may also involve negotiating the terms of leases. If HFMs need assistance with that, the representative in the organization responsible for its real estate portfolio — where the purchases and leasing agreements are kept — may be a good place to start.

HFMs will likely be responsible for developing favorable business agreements with vendors and service contractors and doing the necessary research and risk-benefit analyses before making any large purchases. Those purchases may include maintenance and operations equipment (e.g., air handlers, boilers, HVAC and compressed gas), elements of the physical infrastructure (e.g., ductwork, water piping and electrical systems) and perhaps clinical and diagnostic equipment (e.g., CT scanners and ventilators).

It’s also important for HFMs to look for cost savings that can come from bundling utilities costs that are currently being billed separately to various facilities, locking in a utility rate (if favorable) or using a group purchasing organization that uses the volume of several organizations to get more favorable rates.

HFMs might also be able to partner with another department to reduce costs. At one facility, for instance, the clinical engineering department asked the surgery department for help with negotiating a manufacturer into training the clinical engineers to do the maintenance on their product instead of having to maintain a costly service contract. Together, clinical engineering and surgery were able to get the training they wanted and eliminate that service agreement.

It is important for an HFM to understand the most cost-effective way to replace components or systems that are constantly in need of repair, for which they may not have the funds to replace all at once. A popular strategy among HFMs is to create a capital replacement plan to make replacements incrementally. This strategy works well for things like replacing old cast iron with new PVC pipe or replacing transformers and electric motors. Renovations also offer a great opportunity to update infrastructure.

Patient satisfaction. A patient’s satisfaction with their hospital experience does not depend solely on their health outcome or stem only from the care they receive from doctors, nurses and other clinical staff. In large part, patient satisfaction relates to aspects of the physical hospital environment that the HFM can directly impact. 

These include but are not limited to temperature, lighting, ambiance, the condition of the equipment and even the appearance of the ceilings. So, if a patient is perpetually cold or hot, can’t get good reading light, experiences the furnishings and/or equipment as shabby or old, sees water stains on ceiling tiles or notices other cosmetic or structural damage, they are much less likely to provide a high-satisfaction rating.

Patient satisfaction also depends on the quality of communication between patients and front-line staff. There again, HFMs play a role. If an HFM participated in the PDC process, then they are partially responsible for the layout of the unit and the patients’ rooms. 

So, if the nurse is in a rush because the built environment is designed inefficiently, then patients wind up getting less time and care from nursing staff. If the patient’s room is set up in such a way that the nurse, upon entering the room, immediately has to turn their back to the patient to wash their hands, the patient may interpret the nurse as rude.

Challenging and engaging

An HFM influences the lives of patients: parents, children, members of the community and other loved ones. The job will always be challenging and engaging; it will give HFMs ample opportunities to feel that they’re a vital member of one of the best and most important teams in the world; it will give them a never-ending supply of great stories to tell; and it will leave HFMs feeling proud and gratified to have spent their energy engaged in such a worthwhile and rewarding vocation.

The Introduction to Health Care Facilities Management handbook provides contributors’ stories describing how they found their way into the field of health care facilities management. If a reader can identify with them, or if they just sound like people who would be enjoyable to hang out with, this career might be a good fit.

Readers will notice that most of the contributors discovered this job accidentally — or were even thrust into it unwittingly — but once they’d found it, they embraced it. Some didn’t even want to retire! And they all love their work so much that they have willingly donated their time to explain what they do and why it matters. This job allows one to feel like a vital member of an important team, be the local hero every so often, and get that heartwarming sensation that comes from serving others and seeing their faces shine.

Additionally, many of the folks in this profession are coming up on retirement age and want to pass on what they’ve learned to new up-and-comers. So, when a young HFM enters their ranks, they are likely to find wonderful mentors, characters with great stories to tell and supportive advocates.

Getting all that at the start of a professional career is priceless.

About this new ASHE reference 

The accompanying article was excerpted from the Introduction to Health Care Facilities Management handbook by the American Society for Health Care Engineering of the American Hospital Association.

This introductory book is the first in a trailblazing series, and provides an orientation to the dynamic field of health care facilities management. Along the way, it provides tips and anecdotes from seasoned health care professionals that will be valuable to newcomers, engaging to experienced health facilities managers and thought-provoking to other health care professionals.

Other deep-dive books in this series will include planning, design and construction; compliance; risk; maintenance and operations; finance; administration; sustainability; and qualifications.

Visit the ASHE website for more information about this handbook and the other publications that will be available in the series. 

The article was excerpted and edited by Health Facilities Management magazine staff from ASHE’s new Introduction to Health Care Facilities Management handbook.